Real-World Outcomes of Orbital Atherectomy in Managing Severely Calcified Coronary Artery Lesions: A Single-Center Experience.

BACKGROUND

Coronary artery calcification (CAC) is frequently observed in the ageing population, affecting 90% of men and 67% of women, and poses significant challenges during percutaneous coronary interventions (PCIs). CAC impedes stent passage, compromises drug delivery, and limits stent expansion, contributing to decreased PCI efficacy and heightened risks of complications such as restenosis, thrombosis, and procedural issues.

AIMS: The study aims to evaluate the real-world clinical outcomes of orbital atherectomy (OA) in patients with severe CAC undergoing PCI.

METHODS

This retrospective study analyzed 20 patients (14 males and 6 females) who underwent OA at a single center. OA employed a 1.25 mm diamond-coated burr at 80,000 and 120,00 rpm in selected cases. Baseline characteristics, lesion specifics, and procedural outcomes, as well as changes in minimal lumen diameter (MLD), minimal lumen area (MLA), and minimal stent area (MSA), were assessed along with procedural complications and adverse events.

RESULTS

After OA, a statistically significant increment was observed in MLD and MLA, with mean changes of 2.00 mm and 7.17 mm², respectively. The postprocedural MSA was reported as 6.33 ± 2.85 mm². At 30 days and 6 months after the procedure, only one major adverse cardiac event (MACE), due to stent thrombosis was observed. At 12 months, three MACE (15%) were reported.

CONCLUSION

OA is a promising intervention for managing severe CAC, enhancing procedural success, optimizing luminal gain, and improving stent delivery and expansion while reducing procedural complications.